Thoracic aortic disease Flashcards
what is the right coronary cusp?
the cusp of the aortic valve immediately distal to the right aortic sinus
what is the left coronary cusp?
the cusp of the aortic valve immediately distal to the left aortic sinus
when do women become at greater risk of atherosclerosis?
post-menopause
describe the progression of atherosclerosis?
foam cells fatty streak intermediate lesion atheroma fibrous plaque complicated lesion / rupture
give 3 conditions caused by atherosclerosis?
stroke
MI
aneurysm
what is an aneurysm?
a localised enlargement of an artery caused by weakening of the vessel wall
what is a saccular aneurysm?
aneurysm causing dilatation on one side of the vessel
what a fusiform aneurysm?
aneurysm cauing dilatation on both sides of the vessel
what is a false aneurysm?
aneurysm that involves the collecition of blood between the tunica intima and media of the blood vessel
what can cause aneurysms?
hypertension atherosclerosis smoking collagen abnormalities (Marfan's cystic medial necrosis) trauma infection (mycotic/ syphilis?
what can cause false aneurysms ?
inflammation (endocarditis)
trauma
iatrogenic
what are the signs of false aneurysm?
thrill
bruit
pulsatile mass
what can false aneurysms lead to?
ischaemia
rupture
what are the symptoms of thoracic aneurysms?
asymptomatic
- SOB
- dysohagia and hoarseness (ascending aorts or chronic)
- sharp chest pain radiating to back, possible dissection.
- pulsatile mass
- hypotension
what is a type A aortic dissection?
any aortic dissection that affects the ascending aorta
what is a type B aortic dissection?
any aortic dissection that doesn’t affect the ascending aorta
what are the factors that can cause aortic disection?
hypertension
atherosclerosis
trauma
Marfan’s syndrome
what can dilatation of the aorta lead to (in the aortic valve)?
aortic regurgitation
what are the sypmtoms of aortic dissection?
- tearing, severe chest pain radiating to the back
- collapse (from tamponade, acute AR, esternal rupture)
what are signs of aortic regurgitation on examoination?
- reduced or absent peripheral pulses
- hypotension/hypertension
- soft early diastolic murmur (AR)
- pulmonary oedema
what are the investigations carried out for aortic dissection?
CXR (widenend mediastinum) echocardiogram (false lumens of aneurysms) CT scaning (false aneurysms)
what is the treatment for type A aortic dissection?
surgery
what is the treatment for tye B aortic dissecion?
meticulous blood pressure control
with Beta Blocker and rarelt sodium nitroprusside
what can takayasu’s arteritis cause?
stenosis, thrombosis, aneurysms or aorta and main branches, renal artery stenosis, and neurological symptoms
what is the treatment for Takayasu’s arteritis?
steroids
surgery
what can cardiac syphilis cause?
syphilitic aortitis- aneurysm
aortic regurgitation
what congenital conditions can cause aortic aneurysms?
bicuspid aortic valve
Marfan’s syndroma
coarctation of the aorta
what is associated with a bicuspid aortic valve?
- aortic stenosis
- aortic regurgitation
- coarctation of aorta
- reduced tensile strength of aorta so prome to aneurysm and dissection
what are the 3 types of coarctation of the aorta?
pre-ductal
ductal
post-ductal
what are the signs of coarctation of the aorta?
cold legs
poor leg circulation
before left subclavan artery:
radial-radial delay
right radial-femoral delay
after left subclavian artery:
no radial-radial delay
right and left radio-femoral delay
rib notches
what are the symptoms of coarctation of the aorta?
infancy (severe) -heart failure -failure to thrive later life -hypertension
what imagig is carried out for coarctation of the aorta?
CXR (for rib notching)
CMRI (can visualise coarctation)
what are the CVS conditions associated with Marfan’s?
vascular aneurysm
vascular dissection
aortic/ mitral valve prolapse causing reguritation
